2 INTRODUCTION: is commited to expanding the service of hepatology to help with prevention and treatment of patients with complex liver disease. The aim is to provide all out-patient services related to hepato-biliary disease under one roof. Being diagnosed with a serious liver illness can be very traumatic and stressful for the patient. Such a diagnosis creates enormous uncertainty and raises several questions such as "Are my symptoms going to get worse?" "What will the treatment be like?" "How will my life change?" "Am I going to die?" "Can I get better?" The aims to answer all theses questions and assist all patients with liver disease with a multidisciplinary team approach including : Hepatologist Interventional Radiologist Hepatobiliary Surgeon Liver Clinic Pathologist Diabetologist Psychiatrist Dietician SERVICES OF THE LIVER CLINIC: 1) Liver Wellness Package a) Why should I take the Liver Wellness Package? The reasons for proposing the liver wellness package in apparently healthy individuals with no symptoms are cited below:

3 Most of these diseases including viral hepatitis B, C, fatty liver disease due to alcohol or non alcohol fatty liver disease are silent and do not produce any symptoms. It is advisable to diagnose them early because if left untreated this can result in permanent scarring (cirrhosis) of liver. There is a huge burden of silent liver disease in India. Out of 1.2 billion people in India, at least one in 5 Indians is living with some kind of liver problem 42 million people suffer from Hepatits B (5% of population) 12 million people suffer from Hepatitis C Burden of Hepatitis C is twice of HIV population (more common than HIV) Both Hepatitis B and C, spread in the same way as HIV 8 million Indians are reported to have Alcohol related liver disease. 144 million people suffer from fatty liver disease (12 % of population) 1.5 million suffer from cirrhosis of liver Hepatocellular carcinoma of liver is the 4th most common cause of cancer in the world SILENT LIVER DISEASE : A KILLER Liver cirrhosis can cause life threatening complications like jaundice, bleeding, water accumulation in legs and abdomen and liver cancer. b) Who should avail of Liver Wellness Package? All individuals with history of the following: Obesity, High Waist Hip ratio High Cholesterol, Triglyceride Diabetes Fatty Liver Alcohol intake Previous history of Jaundice Family history of Liver problems.

4 c) What does the Liver Wellness Package include? Blood tests USG abdomen Fibroscan Dietician consult Hepatology Consult. d) How much will the Liver Wellness Package cost? Rs. 13,000/- 2) Fibroscan: To assess the degree of damage done to the liver ( scarring of liver). Advantages : q No preparation needed, q Painless q Non invasive q Results available in few minutes. 3) Speciality Clinic Alcohol and Liver Patient with alcohol related liver disease will require help from Hepatologist to optimise the liver disease, Guidance from Psychiatrist to help with abstinence from alcohol. Supportive information in the form of Alcohol Helpline, information on deaddiction centres and Alcohol Anonymous (AA) Clinic will be provided by the. Non Alcohol Fatty Liver Disease (NAFLD): Common causes of NAFLD are: Obesity, diabetes, hypercholesterolemia, hypothyroidism and hypertension.

5 The Liver clinic aims to provide a holistic a p p r o a c h t o t h i s condition by providing c o n s u l t a t i o n f r o m Hepatologist, Dietician and Diabetologist for these patients. Viral Hepatitis : Viral hepatitis A, B, C, D and E, all present clinically in a v e r y s i m i l a r f a s h i o n, especially in the acute phase of illness. A l t h o u g h, a c u t e v i r a l hepatitis A and E are self limiting, 1% patients can develop fulminant liver failure. Hepatitis B and C can cause chronic hepatitis, which can progress to cirrhosis and liver cancer. Deciding which patients infected with hepatitis Prevention B and to Cure C to treat is challenging and requires detailed assessment which will be provided at the with the help of the Hepatologist. The recommends routine checking for hepatitis B and C for the following individuals: q Previous needle stick injury, Tattoo q Blood transfusion q On dialysis q Previous operations q Family member with this condition Miscellaneous Liver Conditions : will provide management strategies for the following complex liver conditions Evaluation of abnormal liver function test (LFT) and Jaundice.

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